Musings in the life of an internist, cardiologist and cardiac electrophysiologist.

Thursday, May 09, 2013

Former President Bill Clinton Kicks off Heart Rhythm Society Meeting

While the above title is true, I admit that it was used more for garnering readership than suggesting that former U.S. President Bill Clinton had any real news to share with the world's pool of heart rhythm specialists. Oh how we hoped he would tell us about his pacemaker or implantable defibrillator that he had installed but, alas, it was not to be.

But the man can still draw a crowd. The large auditorium was filled by just about everyone that attended the conference it seemed, and he received a standing ovation upon entry. He seemed relaxed, but often glanced down a bit toward the floor when he spoke on occasion as he gauged the audience and weighed his commentary. For the first part of his talk, he stood behind the podium with teleprompters at its side, but unlike other presidents we know, those seemed more for those introducing the former president, rather than the former president himself.

Mr. Clinton was politely received by what could have been a viper's den of cardiac subspecialists. He's a gifted speaker and many of us were impressed by the depth and breadth of humanitarian efforts taken on by his Clinton Foundation following his stint in the White House. It was interesting to hear about all of the places hes been and the work his organization has done and at the outset. After the polished introductory video of the Clinton Foundation's excellent work was shown to the audience of political neophytes, many of whom had never seen a president before, it was clear no one was going to kill the baby seal. This was to be the Bill Show and sadly, there was never a single mention of the support team behind his foundation.

Still, there were moments in his speech that were captivating, especially the part where he described his own post-bypass ordeal of being told that he had fluid around his heart after his heart surgery and how he had to return to the operating room to have "my chest cracked open again" to manage it. We got a glimpse at his real fears and his real appreciation for his doctors and the technologies that cared for him. We heard how he ignored his chest tightness that occurred at rest after his bypass operation and how foolish he felt in retrospect after receiving two stents to a "badly mangled artery." Then we heard about how all of this lead his efforts to change his own dietary habits and to work with PepsiCo to develop policy for school kids to lower caloric intake of sugary drinks: "We found a way to change the system without having to take it down. That's what we need to do."

But his efforts to circle back to health care reform were disjointed much of the time as he waxed back and forth from his experience in Rowanda building clinics and providing logistics to the US, and then to comparing the relatively small Netherlands' health care system to the US's system, leaving many doctors wondering when he was going to say anything of real substance. Still, he tried to make the point about a "systems approach" and paying for "performance" rather than "procedures" as a partial way to fix things. He seemed to yearn for a simpler system than the one we've got. When asked point blank if his perspective on health care had changed since having his expensive care, he masterfully deflected the question by saying "I have a deeply personal regard for the American health care system, but we're limp at preventing errors." No doubt doctors who worked so hard on his behalf appreciated that comment.

Overall, most people I spoke with after the event seemed generally pleased with Mr. Clinton's performance, especially when he admitted the limitations of the Affordable Care Act (ACA). They liked his quip about how 99.5% of people's DNA are identical, yet we spend so much time focused on making sure others know the differences in the remaining 0.5% of their genome. It was clear he was a master at reaching across the aisle and he opined for a more collaborative approach to resolving our nation's health care problems. When asked whether he thought the ACA (Affordable Care Act) would fix what's wrong with America's health care system, he said honestly "Maybe. Maybe not." But he stuck with the partisan narrative of error management, paying by "performance" rather than procedures and asking doctors to do their part to fix the system, seemingly unaware of the 30% drop in RVU payments that took hold 1 January 2013 and the 2% Medicare payments to physicians that recently affected many members of his audience. It seems he felt doctors needed to do more, but many doctors wondered silently how much more we can take.

It was clear the Europeans I spoke with after the talk loved his speech. But they were also quick to point out another little fact: Mr, Clinton's appearance fee is somewhere in the order of $250,000. A quick fact check showed that was a gross understatement: it's closer to $500,000 or more. If this is the price we've paid for this hour of entertainment it's no wonder our health care's cost crisis is such a mess.

And if so, maybe Mr. Clinton should do his part for health care reform, too, and stay home.

6 comments:

I almost decided to boycott HRS this year after hearing that they had invited President Clinton to speak. I knew what his typical speaking fee was and could not believe that the HRS leadership felt it was important enough to spend money in that manner, then charge its members extra fees to attend the VT/VF or AF Summits. Nonetheless, I felt it was more important to mix with my colleagues and catch up with the latest developments in the field, so I came to Denver. Curiosity got the better of me, so I also decided to attend the Clinton speech. I knew we were off to a bad start when he made an initial point about concentration of wealth and a need for redistribution, an oblique reference to doctors being overpaid. He went on to explain how global warming is a major public health problem. Must be reassuring to those who suffered an intense winter in the midwest and northeast. Finally, I felt his remarks did not address issues relevant to his audience: why many of us have had to lose the autonomy which was a mainstay of being a private practice physician, why our work may be progressively undervalued and underpaid in a way which exists for no other profession, why the DOJ persecutes us for not adhering to coverage determinations sometimes outdated by current research or occasionally deviating from those guidelines in the name of patient care using physican judgement, and why the FDA has become a huge barrier to access to new and potentially lifesaving technology for our patients. I would have really appreciated a dialogue about these topics. I would have appreciated some of my colleagues speaking up on our behalf, as well.

While Mr, Clinton's speaking fees are grotesque, I think "sch's" question regarding who paid for Mr. Clinton’s appearance warrants disclosure by our HRS leadership. Did the funding come from a grant provided by Secretary Sibelius of the Department of Health and Human Services? Was it a politically-connected donor? Was it industry? Or was his fee paid by the HRS membership fees? Look, if doctors have to disclose every last conflict of interest we have as part of the Sunshine Act at these meetings, our society's physician leadership should be equally accountable to its society's members to answer this important question.

I also appreciate Dr. Kaplan's assessment of the speech. There is little doubt in my mind that the softball questions Clinton received from the HRS leadership were pre-screened by Mr. Clinton's handlers or Mr. Clinton himself. This is a shame. Important physician issues, much less heart rhythm specialist issues, never saw the light of day. Instead of asking the hard questions, our leadership allowed themselves to be manipulated by the very person whom they asked to attend.

Perhaps on a larger, meta-level, we are seeing something much more concerning: the division of our ranks into the Guild Masters (academicians) and the Journeymen (the clinical EPs). The Guild Masters rely heavily on government and institutional funding while the clinical EP Journeymen are the worker bee-employed physicians struggling to care for patients in an increasingly hostile practice environment. If so, our subspecialty society risks political irrelevance in the years ahead and will further lose its ability to advocate on behalf of our individual patients' needs.

"President Clinton's keynote address is made possible in part through the support of VISIT Denver and the Denver Hotel & Hospitality Community"

So, partly paid for by the people making a ton of money off all the vistors to this thing. I found interesting the juxtaposition of his description of work in the developing world, at one of the least third-world events around.

One can appreciate the content of Dr Kaplan's observations, but sense at the description is that it might have been more entertaining to hear his sax, ".. went on to explain how global warming is a major public health problem. Must be reassuring to those who suffered an intense winter in the midwest and northeast.."

Why physicians may seem to have lost autonomy is that they don't have private practices and patients pay for services with insurance fees. This is the same situation in any medical-related profession. Work is progressively undervalued with introduction of pseudo-docs earning as much money as the MDs (as paid by insurance), the insurers divy up payments and scam health-related consumers leaving less for FDA evaluation of new products, and of course the insurers pay the bills, so they get to determine what is paid, or not.

At one time new drugs and products were made and regulated in the US, but it has been found more than lucratively, but economically feasible for less expensive generics (as well as expensive me-too drugs and products) to be made in third world countries, and sold over the internet, and Congressmen arranging junkets to less expensive pharmacies in Canada (or MDs and dentists to perform medical procedures in third world countries).

About Me

Westby G. Fisher, MD, FACC is a board certified internist, cardiologist, and cardiac electrophysiologist (doctor specializing in heart rhythm disorders) practicing at NorthShore University HealthSystem in Evanston, IL, USA and is a Clinical Associate Professor of Medicine at University of Chicago's Pritzker School of Medicine. He entered the blog-o-sphere in November, 2005.
DISCLAIMER: The opinions expressed in this blog are strictly the those of the author(s) and should not be construed as the opinion(s) or policy(ies) of NorthShore University HealthSystem, nor recommendations for your care or anyone else's. Please seek professional guidance instead.